India has finally cracked down on medical students going to the US for higher studies but deciding to settle down there after completion of their course.

In an effort to cut down on the brain drain that is crippling India’s medical sector, the health ministry has suspended issuing the all important ‘No Obligation to Return to India’ (NORI) certificate, mandatorily required by the US government for any Indian doctor wanting to settle down after a maximum of nine years of medical education.

While the US has one doctor per 469 people, India has one per 2,000.

In a strange dichotomy, the US requires the health ministry (of all developing countries including India) to mandatorily issue a "statement of need" certificate for all medical students going to the US for higher studies. In it, the ministry specifies "how the student is being allowed to go and study medicine in the US because he is required to return and serve India".

Joint secretary in the health ministry S K Rao, who handles international health, told TOI, "We have no problem with students going to the US to study. But the US wants us to first issue a certificate saying we are allowing the student to go and study there because he or she is needed in India and then issue another mandatory certificate nine years later saying he isn’t needed in India so that he can settle down there."

Rao said data with the health ministry showed that only 30% of those who go to study in the US actually return to India after completing their course. "This year, we have not issued a single NORI certificate," he added.

In another important move, India for the first time is close to finalizing guidelines for students going to the US for higher medical education.

Rao said the guidelines would be ready by January. Interestingly, all students who have gone to the US this year had to mandatorily submit an affidavit to the ministry saying once the guidelines are in place, they will abide by them.

"We have sent the guidelines to the law ministry for their comments. It will specify the conditions for medical students to leave India and go to the US for higher education in medicine," Rao added.

In the last three years, 3,000 doctors went abroad for studies but did not return.

Health minister Ghulam Nabi Azad told Parliament on August 28 that around 709 doctors had left India in 2012 (till August 16).

Between April 2011–April 2012, as many as 1,333 doctors migrated to foreign shores. From April 1, 2010 to March 31, 2011, 1,157 doctors had migrated in search of employment and between 2009 and 2010, 1,458 doctors went abroad.

India is desperately trying to increase its doctor patient ratio. In fact, the Cabinet recently cleared the National Council of Human Resources in Health (NCHRH) Bill that allows doctors who hold the Overseas Citizens of India (OCI) card to work in India. The bill also allows NRI doctors to return to India and join medical colleges as faculty.

India has a density of 0.5 doctors per 1,000 people. The MCI intends to reduce the gap to one doctor for 1,000 people by 2031. The Planning Commission says the country is short of 6 lakh doctors, 10 lakh nurses and 2 lakh dental surgeons.

According to the commission, Indian doctors form 5% of the medical workforce in developed countries. Almost 60,000 Indian physicians are working in countries like the US, the UK and Australia alone.

A recent paper in the Lancet said India had eight healthcare workers, 3.8 allopathic doctors and 2.4 nurses per 10,000 population. Compared to other countries, this is about half of the WHO benchmark of 25.4 workers per 10,000 people.

Take the example of All India Institute of Medical Sciences. A first–of–its–kind study by AIIMS’s department of hospital administration found that it takes Rs 1.7 crore to produce a single MBBS doctor at the premier institute.

Over 53% of AIIMS students leave India to work abroad.

GREENER PASTURES
709 doctors have left India in 2012 (as of Aug 16), health minister Ghulam Nabi Azad told Parliament. In the past 3 yrs, 3,000 have left India

India is short of 6L doctors, 10L nurses and 2L dental surgeons, the Planning Commission estimates. Indian doctors make up 5% of the medical workforce in developed countries

AIIMS spends at least 1.7cr to produce a single MBBS. 53% AIIMS students leave India to work abroad